'There is tremendous profit-taking going on in healthcare'

'There is tremendous profit-taking going on in healthcare'

By Modern Healthcare  |  October 24, 2015

Dr. Michael Cropp, president and CEO of Independent Health, a not-for-profit health insurer based in Buffalo, N.Y., discusses surprise medical bills, how his plan reduced premiums this year and his views of prescription drug prices. He spoke with Modern Healthcare reporter Bob Herman.

Editorial: A bungled bundle

Editorial: A bungled bundle

By Merrill Goozner  |  October 24, 2015

Recent history has proved poorly designed payment reforms have unintended and unwanted consequences. The CMS is on the cusp of making that mistake with its plan to bundle payments for replacing knees and hips.

GOP may press for Medicare changes in budget talks

By Shannon Muchmore  |  October 24, 2015

Congressional Republicans may inject controversial healthcare changes into the dealmaking as the debt-ceiling deadline looms on Nov. 3 and the continuing budget resolution is set to expire on Dec. 11.

Study by non-partisan GAO on ACA eligibility flaws draws fire

By Shannon Muchmore  |  October 23, 2015

After a report from the government watchdog said few people were exploiting vulnerabilities in the enrollment process that could allow them to receive insurance subsidies while still enrolled in Medicaid, Democrats in the House called the GAO report just another effort by Republicans to derail the...

CMS will aid New York's struggling duals demonstration

By Virgil Dickson  |  October 21, 2015

The CMS will engage providers in New York in an effort to turn around the state's struggling experiment to coordinate care for low-income and disabled residents eligible for both Medicaid and Medicare. Dual demonstrations around the country continue to struggle with high opt outs, and many are...

Dartmouth-Hitchcock exits Medicare's Pioneer ACO program

By Melanie Evans  |  October 20, 2015

Dartmouth-Hitchcock Medical Center is the latest to pull out of the CMS Innovation Center's Pioneer ACO initiative, Medicare's earliest and most aggressive test of accountable care, which has lost nearly half its initial cohort.

Millennium Health to pay $256 million over allegedly tainted lab claims

Millennium Health to pay $256 million over allegedly tainted lab claims

By Lisa Schencker  |  October 19, 2015

Millennium Health, a San Diego based lab company, will pay the government $256 million to settle allegations it billed the government for medically unnecessary urine, drug and genetic testing and gave free drug cup tests to physicians in exchange for referrals.

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